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Neurophysiological Correlates of Lower Extremity Motor Asymmetries Post-stroke

中风后下肢运动不对称的神经生理学相关性

基本信息

批准号：
8825971
负责人：
Carolynn Patten
金额：
--
依托单位：
VETERANS HEALTH ADMINISTRATION
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-10-01 至 2015-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8825971
关键词：
Accounting Acute Address Admission activity Adult Ankle Behavioral Biomechanics Brain region Characteristics Chronic Clinical Corticospinal Tracts Data Development Distal Flexor Functional disorder Gait Gastrocnemius Muscle Goals Heterogeneity Hip region structure Hospitals Impairment Individual Intervention Isometric Exercise Joints Knowledge Lead Leg Limb structure Locomotion Locomotor Recovery Lower Extremity Measures Medial Mediating Motor Motor output Movement Muscle Neural Pathways Neurologic Neuromechanics Neurorehabilitation Outcome Paresis Pattern Persons Physically Handicapped Physiological Population Prevalence Process Quality of life Recovery Recruitment Activity Rehabilitation therapy Research Research Infrastructure Residual state Scheme Severities Speed Spinal Stroke Testing Therapeutic Intervention Transcranial magnetic stimulation United States Walking Work ankle joint dorsiflexor base behavioral outcome disability hemiparesis improved innovation instrument leg paresis motor impairment neurophysiology novel strategies post stroke primary outcome public health relevance response stem walking rehabilitation

项目摘要

DESCRIPTION (provided by applicant): 1 Stroke is the leading cause of serious, chronic disability in adults worldwide. Over 750,000 new strokes 2 occur in the United States each year accounting for over half of all acute neurological hospital admissions. 3 While two-thirds of persons who suffer a stroke regain ambulatory function, the resulting gait pattern is slow, 4 asymmetrical and metabolically inefficient. Walking dysfunction represents one of the greatest physical 5 limitations post-stroke and improved walking is among the most frequently articulated goals of 6 neurorehabilitation. To date, rehabilitation for walking dysfunction post-stroke has produced highly variable 7 outcomes revealing minimal genuine change in walking function including walking speed or walking pattern. 8 Our long term goal is to improve walking post-stroke. The objective of this application is to investigate the 9 physiologic integrity of neural pathways sub-serving lower extremity function, including walking. The 10 rationale for our proposal stems from our previous work, which has identified distinct patterns of response to 11 therapeutic intervention for hemiparetic walking dysfunction, 'responders' and 'non-responders'. Responders 12 are characterized by significant changes in overground walking speed, multiple changes in spatio-temporal 13 coordination and marked strength changes in distal joints. In contrast, Non-responders produced minimal 14 changes in overground walking speed, few, if any, changes in spatio-temporal coordination, and small 15 strength changes in proximal joints. While the presence of responders and non-responders in the post- 16 stroke population is not surprising, at study baseline responders and non-responders could not be 17 differentiated using clinical instruments of motor impairment, activity, or walking speed. Moreover, clinical 18 characteristics of chronicity and severity failed to predict these patterns of response. Taken together, 19 however, our findings suggest the presence of differences in the functional connectivity of descending tracts 20 subserving key lower extremity muscle groups. 21 Based on our preliminary findings, the goal of this small project is to develop an assessment scheme that 22 will enable differentiation between individuals with the capacity for locomotor recovery from those who lack 23 such capacity. We propose to elaborate our existing methodological infrastructure to enable correlation of 24 neurophysiological functioning in the lower extremity/locomotor regions with clinical and behavioral 25 measures of walking. We will use transcranial magnetic stimulation (TMS) to probe brain regions 26 representing the lower extremity and determine the relationships between: 1) cortical excitability, 2) 27 functioning of and 3) differentiation between cortical and spinal level circuits, and 4) walking function. 28 Keywords: stroke, locomotion, recovery, neurophysiology, rehabilitation, biomechanics 29 30

描述（由申请人提供）： 1中风是全世界成年人严重慢性残疾的主要原因。在美国，每年发生超过750，000例新发中风2，占所有急性神经系统住院的一半以上。3虽然三分之二的中风患者恢复了行走功能，但由此产生的步态模式是缓慢的，4不对称的，代谢效率低下。行走功能障碍是中风后最大的身体限制之一，改善行走是神经康复最常表达的目标之一。迄今为止，卒中后行走功能障碍的康复治疗产生了高度可变的7种结局，揭示了行走功能（包括行走速度或行走模式）的最小真正变化。 8我们的长期目标是改善中风后的行走。本申请的目的目的是研究包括行走在内的下肢功能神经通路的9种生理完整性。我们的建议的10个理由源于我们以前的工作，它已经确定了不同的模式，以11治疗干预偏瘫行走功能障碍，“响应者”和“无响应者”。响应者12的特征在于地上行走速度的显著变化、空间-时间13协调的多个变化和远端关节的显著强度变化。相比之下，无应答者在地上行走速度方面产生了最小的变化，在时空协调方面产生了很少的变化（如果有的话），并且在近端关节中产生了小的强度变化。虽然在16年后卒中人群中存在应答者和无应答者并不令人惊讶，但在研究基线时，使用运动障碍、活动或步行速度的临床工具无法区分应答者和无应答者。此外，慢性和严重程度的临床特征未能预测这些反应模式。然而，总而言之，19我们的研究结果表明，影响下肢关键肌肉群的降束20的功能连接存在差异。21根据我们的初步研究结果，这个小项目的目标是制定一个评估方案，22将能够区分具有运动恢复能力的个人和缺乏这种能力的人。我们建议详细说明我们现有的方法基础设施，使相关的24下肢/运动区域的神经生理功能与临床和行为25步行措施。我们将使用经颅磁刺激（TMS）来探测代表下肢的大脑区域26，并确定以下之间的关系：1）皮质兴奋性，2）27功能和3）皮质和脊髓水平回路之间的差异，以及4）行走功能。28关键词：中风，运动，恢复，神经生理学，康复，生物力学29 30